December 8, 2022

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The fourth dose also divides the flag

While on the Health Department’s table, a plan is in place to expand the administration of the fourth dose of the Covid-19 vaccine to all people over the age of 60 as early as next week – and thus not only to those over 80 who are vulnerable as is currently expected – The debate over whether or not the second booster should be performed (immediately) divides the entire scientific community. With all of Europe back to “dark red” in infection maps and the number of infections in Italy potentially reaching 200,000 a day – as has already happened in France – the platform led by Roberto Speranza is dealing with sticking with the campaign for the fourth dose that has barely reached 20 % among those over 80s and vulnerable: funny numbers, the result also and above all a completely paradoxical and incomplete healthcare connection. But only today, the Italian Hygiene Association issued a note with a very strong position on the so-called “failure” of the vaccination campaign with regard to the fourth dose, in which support for the strategy of the Ministry of Health represents a strong element of weakness, both on the awareness of the risk of Covid and on the lack of participation of vaccination for the groups concerned.

EMA’s position and PRO-BOOSTER . opinions

In the meantime, the EMA is also recommending countries work to increase the number of individuals “eligible” for a second booster, reminding us to hurry, reminding us all that, despite being Omicron variants “highly transferable, we are in a much better position than in previous waves” on Precisely thanks to the high percentage of people vaccinated in Europe.

So is it necessary to change strategy immediately and take the route of mass vaccination throughout the 1960s, modifying vaccines on the original Sars-Cov2 in Wuhan, or waiting fall for an updated product available to everyone – hopefully – to the superfast Omicron?

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Opinions are conflicting: “In my opinion, it is very appropriate to allow a second booster, immediately even with ‘old’ vaccines, for all populations over 60 years of age,” says Professor Fabrizio Brigliasco, Director of Health at the IRCCS Galeazzi Orthopedic Institute and Professor in the Department of Biology Viruses of the University of Milan. “I’m 62 and I’ll take the fourth dose tomorrow too, if I can. Then, in the fall, we can start a massive vaccination for everyone: obviously updated on Omicron and cyclical variants, as is the anti-influenza campaign that repeats every year.” In fact, I’ll say more: You had better start right away with the over-60s age group, rather than narrow the field too much and find yourself in a state of adhesion so low that you have served a contradictory connection to the efficacy of a vaccine based on the original strain.”

Assessment under the risks of COVID-RISK

Nor will there be a campaign to reduce the risk of Covid, as reported by the Italian Association of Hygiene, with health institutions pushing hard at first to the concept of “cooling” and therefore less risky, and now they are surprised by the fact that the weak and those over the age of eighty did not complete their period and prefer to wait The autumn? Brigliasco has no doubts about it: “Yes, certainly. It is relatively true, fortunately, that the virus has subsided somewhat, but not as much as we had hoped. This fact, combined with the fact that the message has been conveyed that at the moment we can To be assured that between September and October we will have updated vaccines, which has generated a state of lack of monitoring and unwillingness to vaccinate on the part of the elderly and even the weak. Nothing is more dangerous and wrong. Also because we do not yet know when exactly the new vaccine will arrive, and above all when we will be able , each of us, from receiving it. It may take us three months to vaccinate the elderly, so we risk Christmas without the new dose. Although the vaccine was produced using the original Wuhan virus as a base, it protects well, and these days only An article published in the British Medical Journal reconfirms the efficacy of the fourth dose for the elderly. So extending beyond the 60s is a very good thing.”

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Contrasting opinions about the booster for over 60 years

However, not everyone has the same opinion, especially with regard to expanding the audience under the age of 80: “In my opinion, and I am not the only microbiologist to think so, it does not make sense at the moment to suggest a fourth dose,” explains Professor Maria Rita Gismondo, Director Clinical Microbiology, Virology and Emergency Biodiagnostics at the Sacco Hospital in Milan, all those over 60.” Currently, the second booster finds its meaning only in management for the frail of any age, and therefore also the very young, and for the very old over They are more than 80 years old, because their age is already an important weakness in itself. Any vacuum campaign is and has ever been implemented, and it must be formulated taking into account some criteria, especially on the ranges it hits and where it causes the most serious damage as a result of its consequences. In my opinion, the current scenario analysis cannot suggest a suggested fourth dose for all 60-year-olds, as it would also be a futile waste of health economics, without evidence of benefits.”

New vaccines and strategies based on history

It is a matter of strategy. And while the new Pfizer and Moderna vaccines updated on Omicron variants are already in the EMA’s periodic review stage, given the importance of the risks, it wouldn’t be a good idea to focus too aggressively on pushing nearly 7 million Novaxes to start the initial cycle and that 80% Those over 80 who have not yet been given the booster drug, rather than considering expanding the audience eligible for the fourth dose?

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“Sure yes,” explains literally “from the field,” Bruno Cacobardo, Head of the Department of Infectious Diseases at Garibaldi Nesima Hospital in Catania (one of the most important hospitals in southern Italy) and professor at Etna City University. I try to explain the reasons clearly as well. The history of vaccines has always been based on 3 phases: preparation, challenge and reinforcement. The first dose puts us in contact with the enemy, the second “summons” and stimulates the system, and the third strengthens the immune response. A fourth dose for the entire population, or a significant portion of it, adds nothing to the usefulness of the vaccine, unless the antigen is altered. Expanding the public now to non-vulnerable 60-year-olds who have already been vaccinated with three doses, and giving them again a vaccine based on the Wuhan virus makes no sense. While it is very important to convince all vulnerable and over 80s to support, because in any case – in the absence of protection – at this moment, these people are in great danger.”